Healthcare Provider Details

I. General information

NPI: 1326088527
Provider Name (Legal Business Name): VIRGIL L ROBERTSON D.C., NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N BREA BLVD SUITE G
BREA CA
92821-3336
US

IV. Provider business mailing address

710 N BREA BLVD SUITE G
BREA CA
92821-3336
US

V. Phone/Fax

Practice location:
  • Phone: 714-671-1150
  • Fax: 714-671-0833
Mailing address:
  • Phone: 714-671-1150
  • Fax: 714-671-0833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP21894
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number16831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: